Anaplasmosis

A 58-year-old man with prior splenectomy presented with 3 weeks of fatigue, fever, anorexia, headache, and jaundice. He lived on a farm in upstate New York. Exam revealed scleral icterus and mild right upper quadrant tenderness. Labs showed leukocytosis with bandemia, elevated liver enzymes, and direct hyperbilirubinemia. Peripheral blood smear revealed intracytoplasmic inclusions in neutrophils (morulae). PCR confirmed Anaplasma phagocytophilum, diagnosing human granulocytic anaplasmosis. Coinfection testing was negative. Doxycycline led to rapid clinical improvement.

A 58-year-old man with prior splenectomy presented with 3 weeks of fatigue, fever, anorexia, headache, and jaundice. He lived on a farm in upstate New York. Exam revealed scleral icterus and mild right upper quadrant tenderness. Labs showed leukocytosis with bandemia, elevated liver enzymes, and direct hyperbilirubinemia. Peripheral blood smear revealed intracytoplasmic inclusions in neutrophils (morulae). PCR confirmed Anaplasma phagocytophilum, diagnosing human granulocytic anaplasmosis. Coinfection testing was negative. Doxycycline led to rapid clinical improvement.